Better BP Programme
The Better BP Programme is designed to give an accurate , reproducible measurement on blood pressure, identify the causative factors, and formulate a management programme for optimal control. We manage the Programme in six steps.
Step:1 Better BP Measurement
Automated Office BP (AOBP)
A programmable device, such as the Omron series, is utilised. This can produce consistent readings in an appropriate environment: the doctor or nurse can leave the room, thereby eliminating conversation which, in itself, can elevate blood pressure reading by up to 20 mm Hg.
Our procedure is:
- Programme an Omron (or similar) device;
- 3 minute rest with doctor or nurse out of the room;
- 3 readings 1 min apart – averaged;
- Repeat if systolic readings vary by more than 20 mm.
Step 2 : Better All Day BP -24 Hour BP
24-Hour Blood Pressure Monitoring determines what BP does over a full day – not just in the doctor’s rooms.
In the case below, persistent hypertension is confirmed.
Step 3: Better Basics-finding the Why of BP
Control of blood pressure lies in the Stress in our Nervous System and the Stretch in our Arteries
These factors are estimated by:
- Heart Rate Variability (HRV): this is a five-minute test of resting heart rate, and measures the nervous activity in the body.
- Pulse Wave Analysis (PWA): this measures the wave form of the pulse at the wrist, and allows an estimation of:central pressure at the heart, which is a more important indicator than the arm pressure; and arterial compliance which, through analysing wave reflection from the periphery, measures the tone of the artery which controls blood pressure.
Step 4 : Better Risk Management- What is my Risk?
Absolute Cardiovascular Risk is then calculated to determine if an individual is low, moderate or high risk
A blood test gives information regarding kidney function, cholesterol and possible diabetes.
Then an electronic risk calculator incorporating age gender , smoking history gives a result in the green ,
orange or red zone.
A target blood pressure is set:
- The normal target is under 140 /90
- (For those with heart disease, or diabetes the target is 130 / 80);
- if kidney impairment is present the target is 120/80.
Step 5: Better Choices -A Logical Approach to Medication
Therapy is based on the causative factors identified through Heart Rate Variability , and Pulse Wave Analysis and Absolute CV Risk:
- Autonomic Dysfunction, as determined by HRV: implies agents which block adrenaline -b-blocker or Physiotens therapy;
- Abnormal Arterial Compliance, as determined by Pulse Wave Analysis: implies agents which act on arterial tone, such as Angiotensin Receptor Blockers (ARB), for example Micardis or Atacand; or Calcium Channel Blockers ( CCBs), for example Zanidep ,and Norvasc; or combined therapy may be required. (CCBs are favoured for Variable Hypertension).
- Central pressure alone is elevated: implies diuretic therapy (for example Natrilix) alone, or in combination.
Most modern agents have minimal side effects, can be used in combinations of two or three agents in a single tablet , and rarely, if ever, produce too low a blood pressure. It is, nevertheless, essential that an adequate fluid intake be maintained when exercising, or in humid conditions.
Step 6: Better Backup
Subsequent steps in our follow-up are:
- monthly – AOBP monitor to target brachial BP;
- 3 months – ECG, PWA, pathology;
- 6 months – Automated Office BP (AOBP);
- 9 months – AOBP;
- 12 months – AOBP, CV review, risk score, PWA.
Generally, our goal (target) BP is obtained within six weeks. Our results in the Viper Study gave an 88% success of treatment to target.